Complications arising from transfemoral, percutaneous implantation of an indwelling port-catheter system for hepatic infusion chemotherapy: Case series of the management and salvage of the system.

INTRODUCTION: Regional hepatic arterial infusion of chemotherapy is performed for unresectable liver tumors via percutaneously implanted port-catheter systems; while these port-catheter systems are effective administration routes, they are associated with various complications. Withdrawal of the system is considered if the complications occur, but repeated hepatic arterial infusion of chemotherapy (HAIC) via an implanted port-catheter system is a last-resort treatment for unresectable advanced liver cancer, and the treatment must be continued. We discuss various cases with complications arising in the indwelling port area in hepatic arterial infusion of chemotherapy and report whether the system was salvaged. METHODS: Between August 2013 and October 2017, eight patients (six males and two females) aged 61-80 years (mean age 76.6 years) with complications arising in a transfemoral indwelling port site for HAIC were referred to our department. All patients requested preservation of the system, especially the catheter. Each patient was assessed for the presence of "gross infection" based on a comprehensive evaluation of clinical findings and blood test results. In cases of "no gross infection," we performed catheter salvage procedures. If there was no clinical improvement following the catheter salvage procedure, the port-catheter system was withdrawn. This research work has been reported in line with the PROCESS criteria. RESULTS: The port-catheter systems were withdrawn in two patients: one due to lasting infection and the other due to ulcer recurrence. Three cases were treated by removal of hematoma through an incision and ointment. The system was withdrawn in one of these cases due to exacerbation of ulcer; thus, the catheters were salvaged in five patients. None of these five patients experienced a relapse from 3 months to over 1 year after the procedure. CONCLUSION: The success of subcutaneous HAIC significantly impacts a patient's prognosis, especially for unresectable tumors and residual tumor recurrences. Initially, we chose to preserve the devices without removal, particularly if there was no infection. However, this approach led to a delay in chemotherapy, prolongation of healing time, and additional complications. These cases demonstrate the importance of a thorough consultation with the patient's oncologist to discuss whether or not the device should be conserved.

Nasal bone clip: a novel approach to nasal bone fixation.

BACKGROUND: Nasal bone fracture is a common injury, but its repair can be unexpectedly difficult. To date, intranasal gauze packing has been used to support the nasal bone in position and to maintain contact between the mucosa of the septum and the cartilage. This gauze packing, however, has a tendency to shift, resulting in an inflammatory response characterized by a foul odor until removal, which detracts from the comfort of the patient. We developed a novel device, the nasal bone clip (NBC), which provides a satisfactory nasal airway and improved comfort. METHODS: A 1.2-mm Kirschner wire and a small piece of hydrocolloid wound dressing are used. The single wire is bent into a double-curved shape, after which each of the 2 tips is curled with pliers. The end of the wire in the nasal passage is covered with a piece of wound dressing to protect the mucosa. After reduction, the external portion of the wire is inserted on the surface of the splint. RESULTS: The NBC was applied in 14 cases: 12 instances of fresh fractures and 2 of old fractures; there were 8 men and 6 women; their mean age was 19.9 years. Complications were not observed; moreover, no patients exhibited problems during the treatment. CONCLUSIONS: The advantages of the NBC are that all materials are available in the operating room or outpatient department, it is low cost, it is readily installable and detachable, it affords superior support for gauze packing, it provides effective external splinting with intranasal support, it never disturbs the nasal airway, and it offers comfort.

Quantitative analysis of the reconstructed breast using a 3-dimensional laser light scanner.

Postoperative cosmesis of the reconstructed breast depends on the interrelation of shape, size (volume), and symmetry. In this study, reconstructed breasts were analyzed with 3-dimensional projections generated by laser light scanning. Fifty-one cases of breast reconstruction following mastectomy (16 cases of rectus abdominis flap, 15 cases of latissimus dorsi flap, and 20 cases of tissue expansion) were evaluated 6 months postoperatively. Shape, volume, and symmetry were quantitatively evaluated. Captured images of the normal breast were mirror-reversed and superimposed on images of the reconstructed breast. Differences in the generated Moire patterns were used to quantitatively compare breasts. The method was rapid, reproducible, and accurate in comparison to thermoplaster casts. It was found that rectus abdominis flaps applied following total mastectomy and latissimus dorsi flaps applied following partial mastectomy gave the best results for their relatively low degree of asymmetry. Application of tissue expansion led to greater asymmetry and poorer overall cosmesis. In conclusion, a 3-dimensional laser light scanning system makes it possible to quantitate the cosmetic outcome following breast reconstruction.